PCORI Biweekly COVID-19 Scan: Identifying Patients With Post-COVID Conditions, Administering Dental Health Care (March 3-16, 2022)
Briefing
The Briefing provides an at-a-glance view of some important developments in the information universe surrounding COVID-19. The views presented here are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders.
The pandemic has reached an inflection point. Data show a dramatic decrease in COVID-19 infection and death rates, and state and national policies embrace endemicity and ease precautions; however, some observations from Europe suggest that Omicron’s BA.2 subvariant might cause an uptick of COVID-19 cases in the United States. The Centers for Disease Control and Prevention (CDC) surveillance estimates that BA.2 accounted for 23% of SARS-CoV-2 infections in the week ending March 12, 2022.
As the US government moves toward cutting pandemic spending, a new road map points to areas that need more investment, from disease surveillance to indoor air quality. The road map provides guidance for addressing the “next normal”, when COVID-19 deaths are closer in-line with the deaths occurring in a bad influenza season, living with and treating post-COVID conditions, and preparing for future pandemics.
There is much still to learn about post-COVID conditions, or Post-Acute Sequelae of COVID-19 (PASC). Some liken the term to cancer, a myriad of conditions occurring throughout the body with biologically diverse triggers that need specific diagnostic tools (see Topics to Watch) and treatments. They caution that 2 years’ experience with PASC is not long enough to bring certainty to the situation. In early March, the Senate Health, Education, Labor, & Pensions (HELP) Committee introduced the Comprehensive Access to Resources and Education (CARE) for Long COVID Act that, if passed, would centralize data, expand research, and help patients access care.
ECRI Horizon Scanning has selected the topics below as those with potential for impact relative to COVID-19 in the United States within the next 12 months. All views presented are preliminary and based on readily available information at the time of writing.
Because these topics are rapidly developing, we cannot guarantee the accuracy of this information after the date listed on this publication. In addition, all views expressed in the commentary section are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders. Topics are listed in alphabetical order.
Immune System Biomarkers to Objectively Identify Patients With Post-COVID Conditions
At a Glance
- Patterns of immune system biomarkers might help definitively identify patients with post-COVID conditions, or PASC.
- PASC encompasses a broad, multisystem range of symptoms lasting months after acute COVID-19, commonly including fatigue, headaches, difficulty concentrating, joint and muscle pain, and breathing problems.
- No laboratory test is available to definitively diagnose PASC and a variety of tests and assessments are often needed to rule out other causes of symptoms before making a diagnosis.
- Immune biomarkers, including cytokines, microRNA, and autoantibodies, can be easily obtained from a blood sample and might facilitate diagnosis and improve time to recovery from PASC.
Description
Identification and management of PASC is a growing challenge for health care providers. As many as 20% of COVID-19 patients are estimated to experience PASC, which encompasses a broad range of new or worsening symptoms lasting months after infection. This commonly includes fatigue, headaches, difficulty concentrating, joint and muscle pain, and breathing problems.
Although a range of established laboratory tests, functional assessments, symptom inventories, and imaging studies can be used to rule out other causes of symptoms and guide treatment, no laboratory tests are available to definitively distinguish PASC from other conditions. Standardizing testing and diagnostic criteria for PASC is an important step toward providing patients with access to multidisciplinary specialists and effective treatments as they become available.
Toward this goal, researchers have identified patterns of disrupted immune biomarkers that might help in diagnosing PASC. Studies conducted at San Francisco General Hospital (California), St Vincent Hospital (Sydney, Australia), and the University of Cambridge (United Kingdom) have identified specific proinflammatory cytokines that are elevated in patients who develop PASC. Researchers from Iran University of Medical Sciences (Tehran) identified 3 inflammation-associated, small, noncoding RNAs (ie, microRNAs) that were expressed at higher levels during acute COVID-19. Two of these biomarkers remained elevated and might help distinguish between acute COVID-19 and PASC. Additionally, researchers from the Imperial College of London (United Kingdom) are developing a diagnostic blood test for abnormal autoantibodies, which they had identified in some patients with PASC and might be causing symptoms by mistakenly attacking the patient’s own body after the acute symptoms have resolved.
We were unable to find cost estimates for investigational immune biomarker tests if used clinically.
Commentary
Concerted efforts are being made to address the long-term fallout of COVID-19, including the impact of PASC on patients and the health care system. The ability to reliably identify patients who have PASC using a standardized set of immune biomarkers might enable earlier intervention and alleviate chronic symptoms.
Early feedback from ECRI internal stakeholders suggested that, if effective, a standardized set of immune biomarkers might facilitate the diagnosis and appropriate management of PASC. This work might inform the development of biomarker-based diagnostic tests to use in future, viral pandemics.
A diagnostic test specific to PASC might reduce the use of other diagnostics and assessments and reduce time to diagnosis and treatment. Early diagnosis and effective treatment might translate to shorter recovery times, reduced health care utilization costs, and improved physical and psychological health outcomes. However, stakeholders noted concerns that the proprietary nature of assays developed to identify PASC might create or worsen health disparities due to varying availability and insurance coverage.
- Categories: Screening and diagnostics
- Areas of potential impact: Patient health outcomes, population health outcomes, patient management, health care delivery and process, health disparities, health care costs
Smartphone Teledentistry to Administer Dental Health Care During the COVID 19 Pandemic
At a Glance
- Teledentistry is a health care model being used by dentists to remotely evaluate patients and administer a variety of dental services including preventative oral health care, dental emergency treatment, and orthodontia.
- The use of teledentistry increased after the onset of the COVID-19 pandemic, because of concerns of SARS-CoV-2 transmission.
- Teledentistry services offered by companies including Toothpic, Dentulu, and Dental Monitoring enable patients to undergo remote assessment, diagnosis, and treatment by a dentist through the sharing of images and medical information through their smartphone application platforms. Remote evaluations may also help in triaging urgent and elective patient dental concerns.
- Many states require private insurance companies to cover teledentistry provided by an accredited dentist. Toothpic offers an out-of-pocket option of $35 to $50 for consultation for a specific issue, preventative care, or a prescription.
Description
Teledentistry is a health care model being used by dentists to evaluate patients and manage a variety of dental care services, including preventive oral health care, dental emergency treatment, and orthodontia.
Concerns about SARS-CoV-2 transmission led to widespread closures of dental practices in March and April 2020. Although the World Health Organization (WHO) recommended in August 2020 that routine, nonurgent dental care be delayed until SARS-CoV-2 transmission rates decreased, the American Dental Association advised patients to continue routine care, noting dentistry is essential health care and plays an important role in overall health. However, fewer patients can be accommodated at dental practices during the ongoing COVID-19 pandemic as a result of staffing shortages, increased safety protocols, and the permanent closure of some dental practices.
Companies such as Toothpic (Brooklyn, New York), Dentulu, Inc (Los Angeles, California) and Dental Monitoring (Austin, Texas) have developed smartphone applications (apps) into which patients can upload images of their teeth and health information for dental evaluation. The Dental Monitoring app uses artificial intelligence to aid in oral observations based off the images. Another app, the Philips Sonicare app, utilizes the network of dentists used by Toothpic to provide on-demand teledentistry, including evaluation, treatment plans, and referral to local dentists as needed.
In September 2020, 50% of dentists responding to a survey by the American Dental Association found increases in stress-related conditions (eg, teeth grinding, cracked or chipped teeth, and jaw pain), while 25% of the dentists also noted increases in cavities and gum disease. Given the ongoing COVID-19 pandemic and emergence of new variants, teledentistry could be a vital patient management strategy to aid in remote consultations, diagnoses, and triaging urgent and elective patient treatment needs.
Many states currently require private insurance companies to cover teledentistry provided by an accredited dentist. Toothpic offers an out-of-pocket option of $35 to $50 for consultation for a specific issue, preventative care, or a prescription.
Commentary
Smartphone teledentistry might increase patient access to oral health care and help triage dental health needs during the ongoing COVID-19 pandemic and beyond.
Early feedback from ECRI internal stakeholders suggested teledentistry could help maintain continuity of dental care, especially for patients apprehensive about possible exposure to SARS-CoV-2 at dental practices. Besides improving oral health outcomes, it might positively impact patients with chronic diseases with established links to oral health (eg, diabetes, heart disease).
Teledentistry might reduce health disparities for certain populations with barriers to in-person dental care (eg, homebound patients, nursing home patients, patients in rural areas), although it could increase disparities for patients without internet or smartphone access.
Stakeholders also thought teledentistry might continue to be used after the pandemic subsides because it streamlines several aspects of dental care and might more efficiently triage patients and schedule appointments. Unique challenges to overcome might include ensuring providers are adequately trained to use teledentistry and helping patients who have difficulties sending pertinent images for the consultation.
- Categories: Systems and management
- Areas of potential impact: Patient outcomes, population health outcomes, clinician and/or caregiver safety, health care delivery and process, health care disparities
Horizon scanning is a systematic process that serves as an early warning system to inform decision makers about possible future opportunities and threats. Health care horizon scanning identifies technologies, innovations, and trends with potential to cause future shifts or disruptions—positive or negative—in areas such as access to care, care delivery processes, care setting, costs of care, current treatment models or paradigms, health disparities, health care infrastructure, public health, and patient health outcomes.
The PCORI Health Care Horizon Scanning System (HCHSS) conducts horizon scanning to better inform its patient-centered outcomes research investments. Initially, PCORI defined the HCHSS project scope to focus on interventions with high potential for disruption in the United States in 5 priority areas: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, mental and behavioral health conditions, and rare diseases. In addition, the system captures high-level disruptive trends across all clinical areas, which may lead PCORI to expand the project scope to include other priority areas in the future.
In early 2020, the COVID-19 pandemic created a fast-moving, widespread public health crisis. In May 2020, PCORI expanded its HCHSS to elucidate the landscape of potentially impactful applications for COVID-19. The HCHSS COVID-19 supplement scans for, identifies, monitors, and reports on emerging and available COVID-19-related treatments, diagnostics, preventive measures, management strategies, and systems changes with potential for high impact to patient outcomes—for individuals and populations—in the United States in the next 12 months.
The HCHSS COVID-19 supplement produces 3 main outputs:
- Biweekly COVID-19 Scans (eg, this document) provide ECRI Horizon Scanning with a vehicle to inform PCORI and the public in a timely manner of important topics of interest identified during ongoing scanning and topic identification or through the ECRI stakeholder survey process.
- Status Reports (quarterly) briefly list and describe all COVID-19-related topics identified, monitored, and recently archived.
- High Impact Reports (every 4 months) highlight those topics that ECRI internal stakeholders (eg, physicians, nurses, allied health professionals, public health professionals, first responders, health systems experts, clinical engineers, researchers, business and finance professionals, and information technology professionals) have identified as having potential for high impact relative to COVID-19 in the United States.
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Commentary in this COVID-19 Scan reflects preliminary views of ECRI Horizon Scanning and internal ECRI stakeholders.
The information contained in this document has not been vetted by other stakeholders.
We welcome your comments on this Scan. Send them by email to [email protected].
Posted: March 28, 2022
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